Delayed ejaculation

Delayed ejaculation describes a man's inability or persistent difficulty in achieving orgasm, despite typical sexual desire and sexual stimulation. Generally, a man can reach orgasm within a few minutes of active thrusting during sexual intercourse, whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30–45 minutes or more.[1] In most cases, delayed ejaculation presents the condition in which the man can climax and ejaculate only during masturbation, but not during sexual intercourse. It is the least common of the male sexual dysfunctions, and can result as a side effect of some medications. In one survey, 8% of men reported being unable to achieve orgasm over a two-month period or longer in the previous year.[2]

Delayed ejaculation
Other namesRetarded ejaculation, inhibited ejaculation
SpecialtyUrology

Signs and symptoms

Delayed ejaculation can be mild (men who still experience orgasm during intercourse, but only under certain conditions), moderate (cannot ejaculate during intercourse, but can during fellatio or manual stimulation), severe (can ejaculate only when alone), or most severe (cannot ejaculate at all).[2] All forms may result in a sense of sexual frustration.[3]

Causes

Medical conditions that can cause delayed ejaculation include hypogonadism, thyroid disorders, pituitary disorders such as Cushing's disease, prostate surgery outcome, and drug and alcohol use.[2] Difficulty in achieving orgasm can also result from pelvic surgery that involved trauma to pelvic nerves responsible for orgasm. Some men report a lack of sensation in the nerves of the glans penis, which may or may not be related to external factors, including a history of circumcision.[4]

Delayed ejaculation is a possible side effect of certain medications, including selective serotonin reuptake inhibitors (SSRIs), opiates such as morphine, methadone, or oxycodone, many benzodiazepines such as Valium, certain antipsychotics, and antihypertensives.[5][6]

Psychological and lifestyle factors have been discussed as potential contributors, including insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing their partner and anxiety about relationship problems.[7]

One proposed cause of delayed ejaculation is adaptation to a certain masturbatory technique.[8] Lawrence Sank (1998) wrote about the "Traumatic masturbatory syndrome", when the sensations a man feels when masturbating may bear little resemblance to the sensations he experiences during intercourse. Factors such as pressure, angle and grip during masturbation can make for an experience so different from sex with a partner that the ability to ejaculate is reduced or eliminated.

Treatment

Sex therapy

Therapy usually involves homework assignments and exercises intended to help a man get used to having orgasms through insertional intercourse, vaginal, anal, or oral, that is through the way to which he is not accustomed. Commonly, the couple is advised to go through three stages.[9] At the first stage, a man masturbates in the presence of his partner. Sometimes, this is not an easy matter as a man may be used to having orgasms alone. After a man learns to ejaculate in the presence of his partner, the man's hand is replaced with the hand of his partner. In the final stage, the receptive partner inserts the insertive partner's penis into the partner's vagina, anus, or mouth as soon as the ejaculation is felt to be imminent. Thus, a man gradually learns to ejaculate inside the desired orifice by an incremental process.[2]

Other

Meditation has demonstrated effectiveness in case studies.[10]

There is yet no reliable medication for delayed ejaculation. PDE5 inhibitors such as Viagra have little effect.[11] In fact, Viagra has a delaying effect on ejaculation, possibly through additional effect in the brain or decrease of sensitivity in the head of the penis.[12]

See also

References
  1. Knowles, David R. (2005-06-01). "Delayed ejaculation". A.D.A.M. Medical Encyclopedia. A.D.A.M., Inc. Retrieved 2007-05-24.
  2. Strassberg, D. S., & Perelman, M. A. (2009). Sexual dysfunctions. In P. H. Blaney & T. Millon (Eds.), Oxford textbook of psychopathology (2nd ed.), (pp. 399–430). NY: Oxford University Press.
  3. Hatzimouratidis, Konstantinos, et al. "Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation." European urology 57.5 (2010): 804-814.
  4. Dias J, Freitas R, Amorim R, Espiridião P, Xambre L, Ferraz L, Adult circumcision and male sexual health: a retrospective analysis, Andrologia, 20 April 2013 doi:10.1111/and.12101
  5. drugs.com > Delayed ejaculation Archived 2019-02-20 at the Wayback Machine Review Date: 6/5/2007. Reviewed By: Marc Greenstein, DO, Urologist, North Jersey Center for Urologic Care
  6. Smith, Shubulade; Robin Murray; Veronica O'Keane (2002). "Sexual dysfunction in patients taking conventional antipsychotic medication". The British Journal of Psychiatry. 181: 49–55. doi:10.1192/bjp.181.1.49. PMID 12091263.
  7. Mann, Jay (1976). "Retarded ejaculation and treatment". International Congress of Sexology.
  8. Sank, Lawrence (1998). "Traumatic masturbatory syndrome". Journal of Sex & Marital Therapy. 24 (1): 37–42. doi:10.1080/00926239808414667. PMID 9509379.
  9. Dr. David Delvin (2007-06-25). "Delayed ejaculation (retarded ejaculation)". NetDoctor.co.uk. Retrieved 2007-10-25.
  10. M. M. Delmonte (June 1984). "Case reports on the use of meditative relaxation as an intervention strategy with retarded ejaculation". Biofeedback and Self-Regulation. 9 (2): 209–214. doi:10.1007/BF00998835. PMID 6391563. S2CID 40959207.
  11. The Carlat Psychiatry Report > PDE-5 Inhibitors: Which to Choose? Published in The Carlat Psychiatry Report. December 2004, Volume 2, Number 12
  12. WebMD Health News > Viagra, Paxil Help Premature Ejaculation. May 29, 2002. By Martin F. Downs.
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